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1-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification.

MedStar author(s):

Citation: Journal of the American College of Cardiology. 71(17):1841-1853, 2018 05 01.PMID: 29699609Institution: MedStar Heart & Vascular InstituteonForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Endovascular Procedures/mo [Mortality] | *Heart Valve Prosthesis | *Heart Valve Prosthesis Implantation/mo [Mortality] | *Mitral Valve Annuloplasty/mo [Mortality] | *Mitral Valve/su [Surgery] | Adult | Aged | Aged, 80 and over | Female | Follow-Up Studies | Heart Valve Prosthesis Implantation/ae [Adverse Effects] | Humans | Male | Middle Aged | Mitral Valve Annuloplasty/ae [Adverse Effects] | Retrospective Studies | Ventricular Outflow Obstruction/et [Etiology]Year: 2018 Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:

0735-1097

Name of journal: Journal of the American College of CardiologyAbstract: BACKGROUND: The risk of surgical mitral valve replacement in patients with severe mitral annular calcification (MAC) is high. Several patients worldwide with severe MAC have been treated successfully with transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic transcatheter valves. The TMVR in MAC Global Registry is a multicenter registry that collects data on outcomes of these procedures.CONCLUSIONS: TMVR with balloon-expandable aortic valves in extreme surgical risk patients with severe MAC is feasible but associated with high 30-day and 1-year mortality. Most patients who survive the 30-day post-procedural period are alive at 1 year and have sustained improvement of symptoms and transcatheter valve performance. The role of TMVR in patients with MAC requires further evaluation in clinical trials.Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.METHODS: This study was a multicenter retrospective review of clinical outcomes.OBJECTIVES: The goal of this study was to evaluate 1-year outcomes in this registry.RESULTS: A total of 116 extreme surgical risk patients with severe MAC underwent TMVR; 106 had a procedure date >1 year before data-lock and were included in the analysis. Their mean age was 73 +/- 12 years, and 68% were female. The mean Society of Thoracic Surgeons score was 15.3 +/- 11.6%, and 90% were in New York Heart Association functional class III or IV. Thirty-day and 1-year all-cause mortality was 25% and 53.7%, respectively. Most patients who survived 30 days were alive at 1 year (49 of 77 [63.6%]), and the majority (71.8%) were in New York Heart Association functional class I or II. Echocardiography data at 1 year were available in 34 patients. Mean left ventricular ejection fraction was 58.6 +/- 11.2%, mean mitral valve area was 1.9 +/- 0.5 cm<sup>2</sup>, mean mitral gradient was 5.8 +/- 2.2 mm Hg, and 75% had zero or trace mitral regurgitation.All authors: Attizzani GF, Bapat V, Chakravarty T, Ciaburri D, Cribier A, DeLago A, Dumonteil N, Dvir D, Eleid M, Eltchaninoff H, Fang HK, Fassa AA, Feldman T, Ferrari E, Gaia D, George I, Guerrero M, Himbert D, Holzhey D, Iyer V, Jones N, Kaddissi G, Kerendi F, Kodali S, Leon M, Mahadevan VS, Makkar R, Martin B, Mathur M, Mishkel G, Nejjari M, Nunes NSV, O'Hair D, O'Neill W, Palacios I, Pavlides G, Pershad A, Piazza N, Rajagopal V, Raybuck B, Reisman M, Rihal C, Rodes-Cabau J, Shah PB, Sinning JM, Sorajja P, Urena M, Vahanian A, Waksman R, Wang C, Wang DD, Webb J, Whisenant B, Witkowski A, Witzke C, Wudel J, Zahr FFiscal year: FY2018Digital Object Identifier:

https://dx.doi.org/10.1016/j.jacc.2018.02.054

Date added to catalog: 2018-05-08

Holdings ( 1 )
Title notes ( 8 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	29699609	Available		29699609

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: The risk of surgical mitral valve replacement in patients with severe mitral annular calcification (MAC) is high. Several patients worldwide with severe MAC have been treated successfully with transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic transcatheter valves. The TMVR in MAC Global Registry is a multicenter registry that collects data on outcomes of these procedures.

CONCLUSIONS: TMVR with balloon-expandable aortic valves in extreme surgical risk patients with severe MAC is feasible but associated with high 30-day and 1-year mortality. Most patients who survive the 30-day post-procedural period are alive at 1 year and have sustained improvement of symptoms and transcatheter valve performance. The role of TMVR in patients with MAC requires further evaluation in clinical trials.

METHODS: This study was a multicenter retrospective review of clinical outcomes.

OBJECTIVES: The goal of this study was to evaluate 1-year outcomes in this registry.

RESULTS: A total of 116 extreme surgical risk patients with severe MAC underwent TMVR; 106 had a procedure date >1 year before data-lock and were included in the analysis. Their mean age was 73 +/- 12 years, and 68% were female. The mean Society of Thoracic Surgeons score was 15.3 +/- 11.6%, and 90% were in New York Heart Association functional class III or IV. Thirty-day and 1-year all-cause mortality was 25% and 53.7%, respectively. Most patients who survived 30 days were alive at 1 year (49 of 77 [63.6%]), and the majority (71.8%) were in New York Heart Association functional class I or II. Echocardiography data at 1 year were available in 34 patients. Mean left ventricular ejection fraction was 58.6 +/- 11.2%, mean mitral valve area was 1.9 +/- 0.5 cm<sup>2</sup>, mean mitral gradient was 5.8 +/- 2.2 mm Hg, and 75% had zero or trace mitral regurgitation.

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